Abstract
Preparation of site of radiation delivery is an important process in radiation treatment
planning and plays a crucial role during a course of radiotherapy to achieve reproducibility
of set-up and accuracy of treatment delivery. The preparation of treatment area is
done by markings of field center, field edge or other reference point of planned field.
Both non-invasive (marker pen, henna) and invasive methods (tattoo) are available
for marking with limitations of each. Tattoo with a needle pricked at angle of 30°
to 1-2 mm depth to create tattoo 2-3 mm diameter in size is an ideal procedure. Visibility,
permanent nature, social-religious belief, and mobility of skin are one of the main
concerns about tattoo. Tattoo removal can be done performed if desirable by patients
by various modern ways, which will be esthetically available. Dermabrasion, cryotherapy,
surgery, QSRL (Q-switched ruby laser) are common methods of tattoo removal. Esthetic
dissatisfaction, allergy, dermatoses, keloids, infection, fanning/fading of tattoo
are associated problems. In IMRT and IGRT treatment, delivery dependence on tattoo
in reduced and use of surrogate markers including particularly for bony set-up and
implanted markers (e.g. gold seeds) for tumor localization and treatment verification
is increasing. However, these are complex procedures and require an expertise. Ease
of set-up and less time required for tattooing are one of the main advantages of tattoo
as compared to external or internal marker set-up. Tattoo still remains a crucial
method of positioning, especially in developing countries and in palliative treatment
settings.
Key words
Radiation oncology - skin marking methods - tattoo
